Albareda Mercè, Caballero Agueda, Badell Gemma, Rodríguez-Espinosa José, Ordóñez-Llanos Jordi, de Leiva Alberto, Corcoy Rosa
Department of Endocrinology, Hospital Sant Pau, Autonomous University of Barcelona, 08025 Barcelona, Spain.
Metabolism. 2005 Aug;54(8):1115-21. doi: 10.1016/j.metabol.2005.03.017.
We prospectively studied 262 women with prior gestational diabetes mellitus (GDM) and 66 control women to compare their prevalence of metabolic syndrome and its relationship with insulin secretion and sensitivity. A 75-g oral glucose tolerance test was scheduled 5 years after delivery along with lipid profile, anthropometrics, and blood pressure measurement. Metabolic syndrome was defined according to the National Cholesterol Education Program 2001, and insulin sensitivity and secretion were estimated with the homeostasis model assessment. Women with prior GDM had similar insulin sensitivity and lower insulin secretion than control women. In comparison with control women, women with prior GDM had higher blood pressure, waist circumference, very low-density lipoprotein cholesterol, and oral glucose tolerance test blood glucose values but, with the exception of fasting hyperglycemia, did not have an increased prevalence of metabolic syndrome or its components. The multivariate prediction of metabolic syndrome and its components was similar with age and current homeostasis model assessment-insulin secretion and resistance indexes or with age, obesity, and GDM. The main predictor was current insulin resistance in the first case and obesity in the second, obesity being the best predictor overall. We conclude that in our population and at midterm follow-up, women with prior GDM have a decreased insulin secretion and display a higher prevalence of fasting hyperglycemia but not the full-blown picture of metabolic syndrome. Obesity, a surrogate index of insulin resistance, is the best predictor of metabolic syndrome at follow-up.
我们对262名既往患有妊娠期糖尿病（GDM）的女性和66名对照女性进行了前瞻性研究，以比较她们代谢综合征的患病率及其与胰岛素分泌和敏感性的关系。在分娩后5年安排了75克口服葡萄糖耐量试验，同时进行血脂谱、人体测量学和血压测量。代谢综合征根据2001年国家胆固醇教育计划进行定义，胰岛素敏感性和分泌通过稳态模型评估进行估计。既往患有GDM的女性与对照女性相比，胰岛素敏感性相似但胰岛素分泌较低。与对照女性相比，既往患有GDM的女性血压、腰围、极低密度脂蛋白胆固醇和口服葡萄糖耐量试验血糖值更高，但除空腹血糖升高外，代谢综合征及其各组分的患病率并未增加。代谢综合征及其各组分的多变量预测在使用年龄和当前稳态模型评估 - 胰岛素分泌及抵抗指数时，以及在使用年龄、肥胖和GDM时相似。在第一种情况下主要预测因素是当前的胰岛素抵抗，在第二种情况下是肥胖，肥胖总体上是最佳预测因素。我们得出结论，在我们的研究人群和中期随访中，既往患有GDM的女性胰岛素分泌减少，空腹血糖升高的患病率较高，但并未出现典型的代谢综合征。肥胖作为胰岛素抵抗的替代指标，是随访中代谢综合征的最佳预测因素。
